Monthly Archives: October 2015

#BreastCancerAwarenessMonth

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Knocking out Triple Negative Breast Cancer: A new paradigm in treatment

Triple negative breast cancer (TNBC) are the subtypes of breast cancer that are generally diagnosed based upon the presence, or lack of, three “receptors” known to fuel most breast cancers:

  • Estrogen receptors (ER)
  • Progesterone receptors (PR)
  • Human epidermal growth factor receptor 2 (HER2)

These receptor proteins are the “eyes” and “ears” of the cells, receiving messages from substances in the bloodstream and then giving instructions to the cells. The most successful treatments for breast cancer target these receptors.

About 10-20% of breast cancers test negative for both hormone receptors and HER2 in the lab, which means they are triple-negative.

Triple negative breast cancer

  • Tends to be more aggressive than other types of breast cancer
  • Tends to be at a higher grade than other types of breast cancer which makes them bear less resemblance to normal, healthy breast cells in their appearance and growth patterns
  • Cancerous cell type is mostly “basal-like” which can be linked to the family history

Hormonal therapies and HER2-targeted therapies work to interfere with the effects of hormones and HER2 on breast cancer, which can help slow or even stop the growth of breast cancer cells. A triple negative breast cancer diagnosis means that the tumour is oestrogen receptor-negative, progesterone receptor-negative and HER2-negative, thus giving rise to the name “triple negative breast cancer.” Since hormones are not supporting TNBC growth, the cancer is not likely to respond to hormonal therapies, including tamoxifen, Arimidex, Aromasin, Femara, and Faslodex. Triple-negative breast cancer also is unlikely to respond to medications that target HER2, such as Herceptin or Tykerb.

On a positive note, this type of breast cancer is typically responsive to chemotherapy. Because of its triple negative status, however, triple negative tumours generally do not respond to receptor targeted treatments. Depending on the stage of its diagnosis, triple negative breast cancer can be particularly aggressive, and more likely to recur than other subtypes of breast cancer.

New therapies in TNBC-management

  • Targeting androgen receptor in TNBC

Triple negative breast cancer is a heterogeneous disease composed of multiple subtypes and oncogenic drivers, including a subtype that may be driven by androgen receptor (AR) signalling. Enzalutamide is a potent AR -inhibitor, which significantly improves optimal strategy in metastatic castration-resistant prostate cancer and is currently being developed for patients with breast cancer who have an androgen-driven gene signature.

The AR pathway is a new target in triple-negative breast cancer in the androgen molecular subtypes. Clinical trials in molecularly selected patients should be designed to explore the combination of enzalutamide with other targeted agents such as PIK3CA (phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha) inhibitors. Enzalutamide may represent a novel therapeutic option in AR-positive patients who would otherwise receive cytotoxic chemotherapy.

  • Designing nanoparticles to counter TNBC

To overcome resistance for chemotherapy in cancer patients, nanoparticles have been engineered that carry the cancer drug doxorubicin, as well as short strands of RNA that can shut off one of the genes that cancer cells use to escape the drug. This “one-two punch” disables tumours’ defences and makes them much more vulnerable to chemotherapy. The new nanoparticles will target a protein found on the surface of triple-negative breast cancer cells and will help to change that. The nanoparticles have three components: a core filled with doxorubicin, a coating of short interfering RNA (siRNA), and an outer layer that protects the particle from degradation in the bloodstream.

Doxorubicin is already used to treat breast cancer and other cancers. It kills cells by damaging their DNA, The researchers based their nanoparticles on the drug known as Doxil, which is packaged in a liposome, or fatty membrane. To improve Doxil’s effectiveness, the researchers combined it with another type of therapy known as RNA interference (RNAi), which uses very short strands of RNA to block the expression of specific genes inside a living cell. They used a technique called layer-by-layer assembly to coat the Doxil particles with one layer of siRNA mixed with a positively charged polymer that helps to stabilize the RNA. This layer contains up to 3,500 siRNA molecules, each targeted to block a gene that allows cancer cells to pump the drug molecules out of the cells.

One of the major challenges that researchers had faced in developing RNAi for cancer treatment is getting the particles to survive in the bloodstream long enough to reach their intended targets. To overcome this, they developed the nanoparticles with an outer coating of hyaluronic acid. These molecules absorb water, allowing the nanoparticles to circulate in the bloodstream undisturbed.

Hyaluronic acid also helps to target the particles to the tumours by binding to a protein called CD44, which is found in great abundance on the surface of triple-negative breast cancer cells.

Turacoz Healthcare Solutions as a socially responsible company spreads the word and awareness and looks forward to collaboration or associations with other agencies/companies with similar goals and aspirations. We have a skilled and competent team of medical writers, clinicians, researchers and biostatisticians. Our clients include major pharmaceutical companies, hospitals and healthcare professionals. Our experience has been in supporting publications, creating regulatory documents, conducting observational studies, designing and creating for print and digital marketing as well as customizing sessions on medical writing. 

#LiverCancerAwarenessMonth

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Liver cancer: Treatment

Liver cancer treatment is generally based on the stage of disease and the patient response to treatment. Treatment is individualized as each patient respond differently. Based on the disease stage, the size, number, tumor location, other co-morbidities, overall health and well-being, the treatment is decided. Based on the complexity of the tumor a team of specialists are associated in the treatment. The team involves surgeons, oncologists, radiologists, gastroenterologists, radiation therapists, and pathologists.

Liver cancer is generally identified in patients who come to the hospitals with damaged livers. Also as the liver cancer stage increases the side effects also may become worse. Therefore, in order to be safe, best options to treat liver cancer should be chosen.

Treatment options

  • The best treatment option is to remove the liver surgically but only <10% of the patients are suitable for surgery. The reasons can be due to cirrhosis (due to bleeding, infection or liver failure), more tumors that are widespread to remove all. Even after successful surgery, there are some tiny deposits of tumors which are not even visible for the scans or surgery. The survival rate of patients having the surgery is >5 years.
  • Other option when there is no evidence of the spread of liver cancer includes liver transplantation. This method involves transplantation of a diseased liver with a healthy liver from a donor. Recent advances in transplantation techniques and immune medications have made transplantation the first choice for patients with cirrhosis and small tumors. The survival rate is >70% with >5 years.
  • Other possible options include injecting the liver with a toxic material such as pure alcohol or chemotherapy in order to destroy it, cryotherapy, radiofrequency ablation etc. These techniques are used in patients with only one or two small tumors, in general.
  • Chemoembolization which involves chemotherapy drugs which can be given directly into the blood vessel that feeds the liver and the tumors. This technique requires a hospital admission, and can cause pain, fever, nausea, and liver damage.
  • Radioembolization or selective internal radiation therapy (SIRT) which is almost similar to chemoembolization in which microscopic radioactive particles are used instead of chemotherapy injected into the blood vessels. This is as effective as chemoembolization for small and multiple tumors.
  • Radiation therapy which uses high-dose energy like X-rays aimed at a small part of the body and can frequently destroy cancer cells. In some cases other techniques like conformal or stereotactic radiation may be useful.

Liver cancer: outcomes

The best treatment options of all discussed above includes surgery and transplantation. Physicians with the help of several tests and scans determines the turmors. Although local treatments such as radiofrequency ablation, cryoablation, and chemoembolization can kill tumors that are visible, “new” tumors may develop which are invisible to the scan or tests. Also, the cirrhosis and conditions that gave rise to the initial cancers will still be there even after successful treatment, so more cancers might actually develop later.

Liver cancer: Prevention

For treating cancers, it not only depends on the type of treatment but also on financial strength. With the growing costs of the machines and drugs one should be able to overcome these. These kind of situations not effect at personal level of the patient.

Hepatoma can be a preventable disease. Hepatitis, alcohol abuse, and obesity can be avoided through

  • Social
  • Medical
  • Lifestyle changes

Also with this transition, there are some chances of improvement observed in the survival rates of liver cancer and hence there is a cause for optimisim.

Liver cancer: Prognosis

The outcome of hepatoma is extremely variable and depends as much upon the state of the liver and the person’s health as on any characteristic of the cancer itself. Therapies such as radiofrequency ablation, chemoembolization, cryoablation, radiosurgery, radioembolization, and systemic therapy are frequently performed sequentially over a patient’s lifetime, depending upon the changes as the disease progresses. Average survival for patients who are able to be treated with these methods is between one and two years.

Multiple techniques can be used in the extension of a patient’s life, while keeping them well and happy. Many drugs have been introduced for the treatment recognizing the molecular defects causing the cancer and few others are still under research. The evolution and improvement in radiologic and interventional technology has helped millions of people in prolongation of their lives. Also the survival rates was almost doubled since early 1990s. Increased and improved medical, scientific, and pharmaceutical areas helped to gain more attention for this disease and still make a better future.

Health tips:

  • Maintain a healthy weight
  • Regular exercise
  • Avoid fad diets (weight loss plans)
  • Limit in the intake of fat
  • Moderate alcohol consumption
  • Regular liver check-ups
  • Quit smoking
  • Be aware of drug risks
  • Vaccinations for hepatitis B

Turacoz Healthcare Solutions as a socially responsible company spreads the word and awareness and looks forward to collaboration or associations with other agencies/companies with similar goals and aspirations. We have a skilled and competent team of medical writers, clinicians, researchers and biostatisticians. Our clients include major pharmaceutical companies, hospitals and healthcare professionals. Our experience has been in supporting publications, creating regulatory documents, conducting observational studies, designing and creating for print and digital marketing as well as customizing sessions on medical writing. 

#WorldOsteoporosisDay

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Since 1997, October 20, is observed as the “World Osteoporosis Day” for raising global awareness on the prevention, diagnosis and treatment of osteoporosis and metabolic bone disease.Every year, International osteoporotic foundation (IOF) launches a year-long campaign dedicated to awareness about osteoporosis that features a specific theme. The 2015 campaign theme is Serve Up Bone Strength, to support the cause, IOF suggest to wear white on October 20 and embrace better bone health. Even though, this year, the World Osteoporosis Day campaign focuses on nutrition of bones, it should be noted that different factors contribute to good bone health and osteoporosis prevention. These include healthy lifestyle, sufficient exercise and osteoporosis treatment for those at high risk. Hence these factors should not be neglected while setting up healthy bones goals.

Bones are living tissues that provide supportive structure to our body, and prevent delicate internal organs from getting damaged by external forces. For optimal functioning of the designated role, bones require nourishment throughout the life. Faulty dietary practices, inadequate nourishment, and sedentary lifestyle in early years of life increases the chances of having weakened bones or osteoporosis in old age.

Osteoporosis is a preventable disease, adequate nutrition and physical activity are the key for building strong bones throughout life and avoiding osteoporotic fractures. The size and the amount of bone contained in a skeleton changes significantly throughout life. Similarly, as the person ages, the specific nutritional needs of his/her skeleton change too. Hence, the rapidly evolving nutritional requirements of the bones should be aptly matched with the diet of the individual. The prime objective of following a bone healthy diet is to help; children and adolescents build maximum peak bone mass, adults maintain healthy bones and avoid premature bone loss, and elderly sustain mobility and independence.

Fundamentals for building healthy bones starts early, from when a baby develops in the womb and during childhood and adolescence, a time when half of a person’s bone mass is accumulated. Therefore, osteoporosis has been termed as ‘a paediatric disease with geriatric consequences’: the consequences of not maximizing the skeleton’s genetic potential in youth become apparent at older age, that clinically manifest as brittle bones and high risk of fractures.

Calcium, Vitamin-D, and proteins are the key nutrients that build up strong bones. Calcium is the building block for bones, 99% of total body calcium is found in bones. Neglecting calcium from diet can lead to negative health outcomes. Dairy foods (milk, yoghurt, cheeses) are the most readily available sources of calcium in the diet, they also contain other important nutrients for growth. Additional food sources include certain green vegetables, whole canned fish with soft, edible bones such as sardines or pilchards, nuts and tofu set with calcium. Vitamin-D is another important nutritional factor required for healthy bones. It regulates calcium absorption from food in the intestine and mineralization of bone. Though sunlight is the most abundant source of Vitamin-D, yet it can also be obtained from vitamin –D fortified food like margarine, breakfast cereals. Protein is indirectly related to bone health. Low protein intake is harmful for the building of peak bone mass during childhood and adolescence. Protein deficiency in elderly is detrimental for the preservation of bone mass.  Other micronutrients that are significantly important in building healthy bones include; magnesium, zinc, and vitamin –K.

Turacoz healthcare Solution urges all of you to spread the awareness about the importance of bone strength and the role of nutrition to build bone strength. We look forward to collaboration or associations with other agencies/companies with similar goals and aspirations. Our team comprises of medical writers, clinicians, researchers and biostatisticians. Our clients include major pharmaceutical companies, hospitals and healthcare professionals. Our experience has been in supporting publications, creating regulatory documents, conducting observational studies, designing and creating for print and digital marketing as well as customizing sessions on medical writing. 

#BreastCancerAwarenessMonth

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Protect yourself from Breast Cancer

  • Over last ten years or so, breast cancer is the most common cancer in most cities in India, and 2nd most common in the rural areas.
  • Although women are highly prone to breast cancer, men may rarely get it.

Know the risk factors

  • Age: More incidences in India occur in women over the age of 40-50. However, breast cancers in young pre-menopausal women tend to be more aggressive.
  • Family history: Women with close relatives or first-degree female relative (sister, mother, daughter) who’ve been diagnosed with breast cancer or an inherited mutation in the BRCA1 and BRCA2
  • Race and ethnicity: White women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of this cancer.
  • Dense breasts due to age, menopausal status, certain medications (including menopausal hormone therapy), pregnancy, and genetics.
  • Exposure to the hormone estrogen:
    • Longer Menstrual periods, i.e., early menarche or late menopause
    • Combined hormone therapy given to women after menopause
    • Parabens and phthalates in cosmetics, hair spray and many other cleaning product fragrances.
  • Previous exposure to radiation for treatment of some malignancy (e.g., lymphoma).
  • Diethylstilbestrol (DES) exposure
  • Environmental pollutants such as organochlorine pesticides.
  • Occupational exposures: Women employed in commercial sterilization facilities (exposure to high levels of ethylene oxide) and the night shift workers (disturbed sleep/wake cycles).
  • Contraceptives: Oral contraceptives (birth control pills) and Depot-medroxyprogesterone acetate, DMPA (injectable progesterone for birth-control).
  • Benign breast conditions: Women diagnosed with certain benign breast conditions might have an increased risk of breast cancer.
  • Lobular carcinoma in situ: Also known as lobular neoplasia, it is an abnormal cellular outgrowth which may become cancerous (invasive) if left untreated for long.
  • Other factors include alcohol-consumption, obesity and lower rates of breast-feeding.

Stay healthy, get screened

A screening plan is planned by the doctor depending upon the unique situation of the patient, if one has been diagnosed with breast cancer.

  • A monthly breast self-exam: Women should know how their breasts normally look and feel and report any breast changes to a health care provider right away.
  • A yearly medical breast exam by a doctor at age 40 and continuing for as long as a woman is in good health
  • Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over
  • One might have one screening test, such as a mammogram, and then have a different test — an MRI — 6 months later.

In addition to the recommended screening guidelines for women at average risk, a screening plan for a woman with a history of breast cancer may include the above screening tests.

  • For women aged 20-30 years, breast self-exam (BSE) is an option for those starting in their 20s. A breast self-exam is when you check your own breasts for lumps, changes in size or shape of the breast, or any other changes in the breasts or underarm (armpit)
  • For women aged 40–49 years, mammography may save lives, but the benefit for younger women may be less than for older women.
  • For women aged 50–69 years, all women in this age group should have mammograms on a regular basis
  • For women above the age of 70 years, screening mammography is probably beneficial for women aged over 70 years who are in good health and have a life expectancy of about 10 years.

Turacoz Healthcare Solutions as a socially responsible company spreads the word and awareness and looks forward to collaboration or associations with other agencies/companies with similar goals and aspirations. We have a skilled and competent team of medical writers, clinicians, researchers and biostatisticians. Our clients include major pharmaceutical companies, hospitals and healthcare professionals. Our experience has been in supporting publications, creating regulatory documents, conducting observational studies, designing and creating for print and digital marketing as well as customizing sessions on medical writing.